How can you help solve the unequal distribution of Doctors in rural and remote areas?

We talk to one of Australia’s leading Emergency Physicians Professor Middleton about the growing problem of FACEM maldistribution and how he believes ED Doctors should commit to either spending time in rural and remote areas as part of their training or during the early years of their FACEM practice.

He also shares some of his most memorable ED career experiences and offers invaluable advice to new FACEMs looking for their first Consultant role.

Congratulations on a hugely successful Resus @ The Harbour conference. It was extremely valuable for the Wavelength Emergency Medicine Team to attend.

How do you think we should tackle the growing problem of FACEM maldistribution in Australia?

I believe it’s important to think of Emergency Healthcare as a system, and this means all Emergency Doctors should commit to either spending time in non-urban areas as part of their training or as part of the early years of their FACEM practice.

We all know there are difficulties with this, for example, the displacement of families, especially with school-age kids and two working parents, but perhaps the earlier in a career the better. I also think there is room for more twinning arrangements where large metro hospitals twin with rural hospitals and potentially undertake a rotational scheme with all their senior Doctors, but perhaps for shorter periods.

Strangely, the private sector has done this well for decades, as well as the public sector to some degree, with Surgeons and Physicians flying out to rural areas for clinics and operating lists. We need to systematise this for EDs as well.

What have you enjoyed most about working in rural and remote hospitals?

You get to work with a greatly differing population, often more unwell, with more advanced pathology. It’s also very rewarding to work in a small community, whether in the hospital or outside. You can make some close friends and have a more connected social time in smaller, more rural places especially.

You’ve worked in numerous Emergency Departments here in Australia, and you must have seen some positive changes in the way they operate during your various tenures. What improvements do you still think need to be made?

The fact is, patients get sick when they get sick not when it’s convenient for an Anaesthetist, Cardiologist, Surgeon or anyone else who is limited to their hospital practice. We cannot, and should not, be functioning in the archaic old ways of having junior or untrained staff, either prehospital or in Emergency Departments, relying on the lucky coincidence of someone knowledgeable arriving to treat them appropriately.

Having highly trained prehospital services with helicopter-based medical staff, enough senior specialists providing front-line care in EDs – rather than just leading junior staff – and responsive hospital in-patient services including radiology is what we need to provide appropriate care to those who deserve it.

The sooner governments, bureaucrats and managers, as well as senior clinicians realise that patients get sick and injured 24 hours a day, 365 days a week – and not just 9-5 Monday to Friday – the better the system will be.

What’s been your favourite Emergency Department to work in and why?

I’ve enjoyed most of them to a large degree so it's often difficult to pick. I trained in London originally so St Mary's Hospital in Paddington and the Royal London Hospital have a particularly important place in my heart, but I also loved Liverpool with a passion. It’s fantastically busy there and the population is often really sick. We admitted almost twice as many people as an average ED.

I also loved smaller Australian EDs such as Mersey in Tasmania as you really feel you make a difference to the community, as well as feeling that the staff respect you and are keen to have you there.

You must have met some fascinating characters on your ED travels. Who particularly inspired you and how?

One of my earliest mentors was Dr Robin Touquet from St Mary's Hospital. He was an ex-Royal Marine Doctor and one of the original 'Casualty' doctors who was grandfathered into the profession in the 1980s. His skills and knowledge were vast in both surgery and medicine and he was a great Traumatologist. But he was also interested in things often not thought about at the time such as the impact of alcohol, devising the Paddington Alcohol Test and taking the time to talk to all of his patients old and young, rich and poor.

He used to say that all of us working in a department were a family, and each training team – we used to rotate in 6-month terms – would be photographed and put up on the wall. He would support you if needed for years afterwards and even though you might have not seen him for a while, he would welcome you back and always know what you’d been doing. He was a true inspiration for a lot of people.

And finally, what valuable advice would you give to new FACEMS looking for their first Consultant role?

Don't rush! People often advise you to rush through the training and get a job as soon as possible. But there’s no need because you’re going to spend a long time in one place once you secure a Consultant role.

Get as much interesting stuff done before you take a permanent post. I spent a year as a Fellow in Paediatric Emergency Medicine, a year as an ICU Fellow and a year as a Prehospital and Retrieval Fellow having fun in helicopters before several years part-time doing the same thing.

Thanks so much for your valuable insights into how we can help solve the shortage of Doctors in rural areas and for sharing your Emergency Medicine career experiences with us Professor Middleton.

Wavelength is particularly passionate about recruiting doctors to communities where they will make a significant difference. It could not be more fulfilling. We work with hospitals and clinics in rural and remote communities to find the very best Emergency Medicine Doctors, Specialists and General Practitioners. In fact, we look forward to catching up with many Doctors who share a passion for rural and remote medicine at this year’s Rural Medicine Conference in Darwin, 25 – 27 October.

Are you attending Rural Medicine Australia (RMA) 2018?

If you are, please pop by for a chat, share your views on how we can solve the shortage and maldistribution of Doctors in rural and remote areas, and check out the latest locum and permanent roles we currently have available in Emergency Departments across Australia. Don't miss our giveaways for Doctors who join our network during the event.